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General NPI Number Information
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NPI Number | 1366635740
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Entity Type | Organization
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Legal Business Name | SANFORD CLINIC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 433 KANSAS AVE SE
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City | HURON
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State | SD
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Zip | 57350-2561
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Country | US
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Telephone | 605-352-2117
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Fax | 605-325-5513
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | STEVE GOETSCH
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Credential |
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Telephone | 605-328-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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